Imagine what it would be like to live in a city under siege. Now imagine that you are just weeks, or even days, away from giving birth. Do you remain where you are, knowing that when the time comes you may have to deliver with no medical assistance? Or do you leave everything you know behind, and flee your home in the hope that you might be able to safely deliver elsewhere?
In Syria, the raging conflict between Bashar al-Assad’s government and Syrian rebel forces has caused more than 1.6 million Syrians to flee into neighboring states where they live as refugees. Another 6.8 million people remain in Syria in desperate need of humanitarian assistance. When a crisis of this magnitude hits, the basic reproductive health needs of those affected do not decrease. What does change is their ability to access vital reproductive and maternal healthcare.
More than two years of conflict has caused health care systems in Syria to collapse. More than half of the nation’s hospitals have been severely damaged or destroyed in the fighting. Pharmaceuticals and other medical supplies are extremely difficult to come by and many trained health providers have fled the country. Ongoing fighting means that even getting to a medical facility can be a dangerous journey. In many areas, the limited resources available are being diverted to care for wounded combatants, leaving women with few places to turn for healthcare.
As a result, access to family planning services have decreased in many areas within the country. The stress, trauma and uncertainty of war and the daunting journeys of those desperate to escape the violence has led to an increase in miscarriages and premature births. The number of women suffering complications from unsafe abortions (abortion is illegal in most circumstances in Syria) has also risen during this time.
Pregnant women are one of the most vulnerable groups affected by the Syrian crisis. The United Nations Population Fund (UNFPA) estimates that before the end of this year more than 270,000 women are likely to give birth within Syria. Prior to the conflict nearly all these women would have given birth under the supervision of a skilled attendant, but today that option is available to very few, making delivery a risky ordeal.
Concerned that they will be unable to access safe delivery services when they go into labor, some Syrian women are electing to schedule cesarean sections, but limited maternity facilities are often over-capacity leading hospitals to limit hospital stays to a maximum of 12 hours for those delivering by C-Section and 6-8 hours for normal deliveries. Other Women are attempting to flee across the border into Jordan or Turkey, where they are more likely to be able to have safe deliveries. However, some women have failed to make it to the relative safety of refugee camps in time and have gone into labor during the journey.
Clinics in Za’atari refugee camp, in northern Jordan, provide ante- and post-natal care, while additional field hospitals operated by Jordanian, French, Moroccan and Emirati agencies have doctors and midwives on hand to deliver babies. Still funding and resources are limited and there is only one doctor in the camp able to perform C-sections. For the bulk of Syrian refugees who live in urban areas outside of the camps, health services may be more difficult and costly to access.
While the situation facing pregnant women in Syria is appalling, it is not unique. In times of conflict, reproductive health needs, such as family planning services to prevent unintended pregnancies and comprehensive maternal health care, can often be overlooked as other vital services such as food and shelter are often prioritized by donors and agencies. On World Refugee Day, it is crucial that we remember that comprehensive reproductive health services are also a form of life-saving humanitarian aid.